Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
II4 .1
I COMMUNITY DEVELOPMENT Permit#: FPS2019-00151
T I C.z AR ID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/17/2019
Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11577 SW PACIFIC HWY
Project: Bridgetown Optical Subdivision: None Lot: None
Project Description: Fire sprinklers. Moving and adding(5)sprinklers.
Contractor: FIRESTOP CO Owner: FRED MEYER STORES INC
3203 NE 65TH ST#2 STORE#375
VANCOUVER,WA 98663 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 360-718-8604 PHONE:
FAX: 360-718-8603
FEES
Description Date Amount
Specifics: Permit Fee-COM 12/17/2019 $91.44
12%State Surcharge-Building 12/17/2019 $10.97
Type of Use: COM Plan Review-Fire Life Safety-COM 12/17/2019 $36.58
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 12/17/2019 $2.00
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .10 Design Area: 1500
K Factor: 5.62
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $140.99
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,000.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are sei forth in O.•' 952-001-0010 through OAR 952-001-0090. You ma obtain a copy of the rules
or direct questions to OUNC b lin�3.232.191 .r 1.800 .•2.234 1.95 , .
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Issued By: :4! Permittee Signature: L
111111 d
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ler
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
City of Tigard Permit No.: `d P6k/«—"CO/C1
. ane SW Hall Blvd.,Tigard,OR 9DECn
Phone: 503.718.2439 Fax: 503.598.198.19 60 a � 1 2019 Date Received: /AZ// 77/,
Inspection Line: 503.639.4175
TIGAKD :e i Y (J 14.ir4r L. / �,
Internet: www.tigard-or.gov By: I t.r 4 4,�/ /
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: -'OEg is J L 6 eT%c (`. Occupancy: b€ r %G C
Job Address: l t 5 Ti S w 004,t i—t L t4 4,Kry Type of Construction:
Suite:
Contractor: S rob 9 C o . Phone: 5 3 - S(.8 - G 2.'S c
Number of Proposed or Altered Heads: 5-
Type:
Type: S S f Hazard: L. C�.�-.t 'i Density: . f O (S v d
I, Gt#b.OJ) t�.0�t2 Oregon Construction Contractors Board No. t 6 3 Z? 5
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard occupancy.
b) Positions of sprinkler heads relative to architectural features such as soffits,beams,partitions, walls, etc.
complies with current adopted edition of NFPA 13.
c) The proposed work does not require hydraulic calculations.
d) Only one sprinkler head will be installed from one drop (exception: up to two heads from one drop may be
installed when each head is in a separate fire area).
e) The area covered per sprinkler head is limited to the spacing requirements of NFPA 13.
f) Tenant improvements in a new building shall be equipped with Quick Response heads (see 2002 NFPA 13,
Section 8.3.3.1 for exceptions).
g) The installation shall comply with the requirements of the current adopted edition of NPFA 13.
h) Piping shall not be concealed until hangers and bracing are inspected.
i) Final approval shall be subject to onsite tests and inspections.
In addition, I understand the following is required:
• Submit(3) copies of a sketch showing the area of work within the building's structure.
• Building fire protection system permit.
• A copy 0 his ocument ith a copy of the sketch attached shall be available for all inspections.
Signature: Date: k Z - Z - t9
Print Name: �tG i 460.0 t 1..4. 0 CL
I:\Building\Forms\FireSprinklerAffidavit 071514.docx Page 1 of 1
Building Permit Application
Fire Protection System
Received
13125 W Tigard Date/By: J,2 (/7 /e Pe ..v32.1,61,,,.....00
)S j
• 13125 SW Hall Blvd.,Tigard OR 97223 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T 1(;.\K D Inspection Line: 503.639.4175 Date Ready/By. !oris: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
1 TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
..Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling 531,Comtnercial/industrial
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ``g"'7 Stu Pac1Fke `,,F'.e y New dwelling area: square feet
City/State/ZIP: T l G.t20 C Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:%Rt OGEE'0444 p P t kCAlr Covered porch area: square feet
Cross street/directions to joh_site: Deck area: square feet
7
S W 2. t.I.2 j ve. Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ �v
Kove. 7f\pp S(�t2«tKL�RS AS 2 • oon '
��ltQ V t a e O Teo_ Me,Cr— C ooh Existing building area Z V v square feet
(c) h ree. . New building area: rty(at square feet
lul PROPERTY OWNER 5LTENANT Number of stories: I,
Name: Q((k 0 CZE.To Vida.& O.el'r, c( L.. Type of construction:
Address: `k S 1 1 V.[ C"NGk 4=1, I.-4W Occupancy groups:
City/State/ZIP: 'c t G Art..) , 0(. ' Existing: NC
Phone:( ) I Fax:( ) New: X
'n APPLICANT 0 CONTACT PERSON
NOTICE
Business name: e.t tE t t^V e C o . All contractors and subcontractors are required to be
Contact name: RA.u�( I t t...1 02 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: '3 2.o 1,4E-1,4E- C _ T= S -cc-2-1 t-r. seA«- 2. i jurisdiction in which work is being performed.If the
City/State/ZIP: V At.tC.Oud Ca, 6,1A ' y 8 GG 3 applicant is exempt from licensing,the following reasons
apply:
Phone:(3Co) 718_ 860 4 Fax::( ) l`t A
E-mail:( ct.%):00.15041x2€l t2t:STO eco . C014,
CONTRACTOR RUILDLNG PERMIT FEES*
i
Business refer to feesc le)
S nrMe_
Address: Permit fee:
Cit /State/ZIP: State surcharge(12%of permit fee):
Y
R 1 FLS plan review(40%of permit fee):
Phone:( ) l Fax:t ) ) (Due upon application.)
CC 33)., / .
Authorized s Amount
This permit application expires if a permit is not obtained
Print nameAZ3,c,,,t,y,j ) (Sbe 440 _ I Date:( Z_.t 7 - ( 9within ISOdays atter it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
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City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) D New l 2.) Modification to sprinkler heads only:
❑ Addition fig. 1-10 heads: No plan review required.
gl Alteration 0 11+heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A,B,Cor Das applicable):
A.) Commercial Sprinkler
. Wet I 0 Dry
Additional Standpipes
Information: Hazard Group
Density. , (C / ( Cb u
Design Area
K: Factor
Sprinkler Project Valuation: $
B.) Type I- Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations 0 Yes
include: Individual Component 0 Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler(Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq.ft.
Fire Protection Permit Fees
Project valuation subtotal (see A,B&C above): $ 1. :..4)Cw .
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $
FLS Plan Review(40%of permit fee): $
TOTAL: $
Plan review requires a completed application and three(3) sets of plans at submittal.
Plan review fees are required at submittal.
I:\Building\Permits\FPS-PermitApp.doc 02/01/2011 2